rTMS of the prefrontal cortex in the treatment of chronic migraine: a pilot study

Brighina, Filippo; Piazza, Aurelio; Vitello, G.; Aloisio, A.; Palermo, Antonio; Daniele, Ornella; Fierro, Brigida

doi:10.1016/j.jns.2004.08.008

Cited by 241 publications

(205 citation statements)

References 21 publications

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“…Based on the hypothesis that the left dorsolateral prefrontal cortex (LDLPFC) is hypoactive in chronic pain disorders, Brighina et al [102] studied the effect of excitatory high-frequency (20 Hz) rTMS over the LDLPFC in 11 chronic migraineurs. After 12 sessions of rTMS, attack frequency, headache index and acute medication intake were reduced for up to 2 months, while there was no significant improvement in five patients receiving the sham stimulation.…”

Section: Central Neurostimulationmentioning

confidence: 99%

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Paemeleire

Louis²,

Magis

et al. 2014

Acta Neurol Belg

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Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres

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Section: Central Neurostimulationmentioning

confidence: 99%

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Paemeleire

Louis²,

Magis

et al. 2014

Acta Neurol Belg

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“…Interestingly, considering that the dorsolateral prefrontal cortex (DLPFC) exerts an inhibitory control on pain pathways in humans, Brighina et al [23] explored the effect of 12 daily sessions of high-frequency rTMS over the left DLPFC in a small sham-controlled study of 11 CM patients. They found a long-lasting reduction in attack frequency, number of tablet intake, and headache index in the effectively treated (n=6) compared to the sham-treated group (n=5).…”

Section: Transcranial Magnetic Stimulationmentioning

confidence: 99%

Cortical Excitability in Chronic Migraine

Coppola

Schoenen

2011

Curr Pain Headache Rep

101

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A proportion of episodic migraine patients experiences a progressive increase in attack frequency leading to chronic migraine (CM). The most frequent external factor that leads to headache chronification is medication overuse. The neurobiological bases of headache chronification and of the vicious circle of medication overconsumption are not completely elucidated. More recently, the same neurophysiological methods used to study episodic migraine were applied to CM and medication-overuse headache (MOH). Studies of cortical responsivity tend overall to indicate an increase in excitability, in particular of somatosensory and visual cortices, reflected by increased amplitude of evoked responses, decreased activity of inhibitory cortical interneurons reflected in the smaller magnetic suppression of perceptual accuracy, and, at least for visual responses, an increase in habituation. In MOH, overconsumption of triptans or NSAIDs influences cortical excitability differently. Generalized central sensitization is suggested to play an important role in the pathophysiology of headache chronification.

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“…Several studies have also indicated abnormal cortical function in people with CLBP (Giesecke et al, 2004;Baliki et al, 2008;Lloyd et al, 2008;Kobayashi et al, 2009;Tagliazucchi et al, 2010). Evidence from pain neuroimaging and transcranial magnetic stimulation studies has linked the DLPFC to pain modulation (Lorenz et al, 2003;Brighina et al, 2004;Fierro et al, 2010), placebo analgesia (Wager et al, 2004;Krummenacher et al, 2010), perceived control of pain (Pariente et al, 2005;Wiech et al, 2006), and pain catastrophizing (Seminowicz and Davis, 2006).…”

Section: Introductionmentioning

confidence: 99%

Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function

et al. 2011

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Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, we assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes. We acquired MRI scans from chronic low back pain (CLBP) patients before (n ϭ 18) and 6 months after (spine surgery or facet joint injections; n ϭ 14) treatment. In addition, we scanned 16 healthy controls, 10 of which returned 6 months after the first visit. We performed cortical thickness analysis on structural MRI scans, and subjects performed a cognitive task during the functional MRI. We compared patients and controls, as well as patients before versus after treatment. After treatment, patients had increased cortical thickness in the left dorsolateral prefrontal cortex (DLPFC), which was thinner before treatment compared with controls. Increased DLPFC thickness correlated with the reduction of both pain and physical disability. Additionally, increased thickness in primary motor cortex was associated specifically with reduced physical disability, and right anterior insula was associated specifically with reduced pain. Left DLPFC activity during an attention-demanding cognitive task was abnormal before treatment, but normalized following treatment. These data indicate that functional and structural brain abnormalities-specifically in the left DLPFC-are reversible, suggesting that treating chronic pain can restore normal brain function in humans.

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rTMS of the prefrontal cortex in the treatment of chronic migraine: a pilot study

Cited by 241 publications

References 21 publications

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Cortical Excitability in Chronic Migraine

Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function

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